Adult secondary mental health services: consultation analysis

Executive summary

Introduction

1. This document provides a summary of the consultation analysis of the Quality standards for adult secondary mental health services. As the consultation document contained many questions this summary provides a high-level overview.

2. The public consultation, which ran for 13 weeks from 14 December 2022 to 17 March 2023, received 102 validated responses. There was a relatively equal split of responses from individuals and organisations. The consultation attracted responses from a wide range of organisations, including: Health Boards, Health and Social Care Partnerships (HSCP) and services; health improvement organisations; mental health organisations; and organisations who support specific target groups.

3. The consultation was supplemented by several in-person and remote stakeholder events.

The consultation

4. The consultation was split into seven sections, with most structured in the same way (that is they contained the same closed questions).

5. Overall, there was a high level of support for the standards. Responses to closed questions shows that a majority of consultation respondents agreed or strongly agreed that the standards will:

• improve the experience of people using services
• improve outcomes for people using services
• clearly set out to individuals, their families and carers what they can expect from a secondary mental health service
• help to meet everyone’s needs regardless of their background

6. While a majority of respondents ‘agreed’ with all closed questions (albeit to varying degrees) – and therefore expressed support in principle with the standards - there were some questions which attracted mixed feedback. For example, in some cases upwards of almost one-third of respondents ‘neither agreed nor disagreed’ with particular statements.

Key themes

7. Several key themes emerged from the consultation submissions leading to considerable repetition of points and views across the question set (that is points raised by many respondents). Rather than repeat these themes throughout the summary, they have been summarised once below.

The standards:

• further clarity, detail, guidance and consultation was requested on how the standards would be implemented, monitored, and audited
• there was a request for the standards to be clear, concise, appropriately described and defined, specific, measurable, and easily understood
• any terms used within the standards should be defined, consistent and not interchangeable (for example, “adult”, “care”, “support” and “treatment”)

Resources

• budgetary pressures and workforce challenges mean that constrained resources may make it difficult for services to meet and maintain the standards
• adequate and sustained financial resources for increased staffing and other support (for example, workforce planning, workforce development, continuing professional development, and digital infrastructure/support) are needed to build workforce capacity and capability
• some standards may also raise expectations of delivery of care which cannot currently be met

Services and service providers

• person-centred, collaborative care and holistic approaches are viewed as a key component of the delivery of adult secondary mental health services
• inclusive information and communication are considered essential - in plain English, in different languages, and in other accessible and user-friendly formats
• there could be more effective interfaces and improved information sharing, communication and collaborative working between services and professionals in the public, third and private sectors
• there could be more explicit reference to the role of primary care across the standards (that is, general practice and community pharmacy) as this is usually a person's first point of contact – for example, how the standards would interface with primary care, and how roles in primary care would complement care delivered by secondary services
• it was considered imperative that the standards seek to understand the wider social determinants of health in seeking to reduce inequalities in mental health (for example, housing, income levels, access to transport) – but also recognise that these factors are complex and largely out with the control or influence of adult secondary mental health services

People with lived experience

• the standards need to continue to foster a change in attitudes - people should be supported and empowered to be equal partners in their own care
• the views, experiences, and priorities of people who use adult secondary mental health services, their families and carers, and the workforce should remain connected to service development and policy

8. Note: The following sections in the summary outline any additional qualitative feedback from respondents - that is, feedback that is not described above in the key themes section.

9. More specific feedback on individual standards is contained in Appendix E.

Part 1: General comments on the standards

10. Key points to note from respondents on the standards more generally included that the standards could be applicable:

• to anyone who needs to access secondary mental health services regardless of age – for example: children, adolescents, and older adults
• to other parts of the healthcare system – for example: primary care; tertiary care; community health; third sector mental health services; in-patient care; crisis support; forensic services
• to other services where there are transitions - for example, alcohol and drug recovery

Part 2: Access

11. A majority of consultation respondents who answered the closed questions relating to the access standards expressed agreement (to varying degrees):

• 70% said it would improve the experience of people using services
• 57% said it would improve outcomes for people using services
• 68% said it clearly set out to individuals, their families and carers what they can expect from a secondary mental health service
• 58% said it would help to meet everyone’s needs regardless of their background

12. Some respondents felt that achievement of the access standards may be difficult given current resource constraints experienced by adult secondary mental health services (for example, under-funding of services, staff shortages) and wider factors (for example, access to public transport for people living in remote and rural communities and digital and geographical connectivity issues).

13. The importance of inclusive communication was emphasised - in plain English, in different languages, in other accessible and user-friendly formats, as well as the important role of interpreters.

14. Some respondents also raised points relating to the links between transparency and accountability of the access standards and their impact on service delivery and managing expectations. It was suggested that services would need to have appropriate governance, policies, resources, and staff in place to establish the roles, responsibilities and lines of accountability required to deliver the standards.

Part 3: Assessment, care planning, treatment, and support

15. A majority of consultation respondents who answered the closed questions relating to the assessment, care planning, treatment and support standards expressed agreement (to varying degrees):

• 67% said it would improve the experience of people using services
• 62% said it would improve outcomes for people using services
• 69% said it clearly set out to individuals, their families and carers what they can expect from a secondary mental health service
• 64% said it would help to meet everyone’s needs regardless of their background

16. Some respondents provided feedback that could be described as key principles to help underpin effective delivery of the assessment, care planning, treatment, and support standards. These respondents considered it important that this set of principles were fully reflected within the final standards and wider commentary.

17. Some principles raised relate to people with lived experience of accessing and using adult secondary mental health services (for example, access and choice on the right services at the right time and in the most appropriate setting based on a person’s needs), while others relate to services themselves (for example, adopting person-centred and holistic approaches to assessment, care planning, treatment, and support).

18. Some respondents felt that the assessment, care planning, treatment, and support standards as set out in the consultation document could be amended, reworded, reframed, enhanced, and/or further strengthened in some way.

Part 4: Moving between and out of services

19. A majority of consultation respondents who answered the closed questions relating to the moving between and out of services standards expressed agreement (to varying degrees):

• 70% said it would improve the experience of people using services
• 61% said it would improve outcomes for people using services
• 72% said it clearly set out to individuals, their families and carers what they can expect from a secondary mental health service
• 56% said it would help to meet everyone’s needs regardless of their background

20. Respondents also outlined key principles to help underpin effective delivery of the moving between and out of services standards. For people with lived experience, this included for example, access to consistency of care and treatment – to ensure that they do not have to constantly retell their experiences and only have to tell their story as few times as possible.

21. For services this included for example, ensuring open and strong lines of communication and improved information and record sharing, including between primary and secondary care services, social work, addiction services.

22. A few respondents suggested that something was missing. As above, this reflects calls from respondents for more detail, specification, and/or greater clarity on these standards, as well as proposed changes to language, wording, and terminology.

23. Most respondents also expressed strong support that the moving between and out of services standards should include a specific standard on support for people with lived and living experience of substance use. It was considered important that any such standard should align with existing strategies, plans, and standards (for example, National Drugs Mission Plan: 2022-2026 and Medication Assisted Treatment (MAT) standards) and with existing workstreams (for example, the development of the shared Health and Social Care Record).

Part 5: Workforce

24. A majority of consultation respondents who answered the closed questions relating to the workforce standards expressed agreement (to varying degrees):

• 65% said it would improve the experience of people using services
• 61% said it would improve outcomes for people using services
• 59% said it clearly set out to individuals, their families and carers what they can expect from a secondary mental health service
• 55% said it would help to meet everyone’s needs regardless of their background

25. Much of the qualitative feedback from respondents on the workforce standards highlighted the range of workforce challenges experienced by adult secondary mental health services (for example, staff shortages, staff burnout and wellbeing).

26. A few respondents felt that the workforce standards could go further to better support workforce wellbeing, and that more action was needed to increase involvement of people with lived experience within the mental health workforce.

Part 6: Governance and Accountability

27. A majority of consultation respondents who answered the closed questions relating to the governance and accountability standards expressed agreement (to varying degrees):

• 66% said it would improve the experience of people using services
• 61% said it would improve outcomes for people using services
• 69% said it clearly set out to individuals, their families and carers what they can expect from a secondary mental health service
• 54% said it would help to meet everyone’s needs regardless of their background

28. Additional feedback on governance and accountability standards included that there should be a range of ways to gather the views and experiences of people with lived experience, as well as a clear complaints process.

Part 7: Implementation and Measurement

29. Half of respondents who answered the closed question agreed or strongly agreed that some of the standards should be measured using a validated self-assessment tool (many of the remainder were unsure). There was additional feedback that: the workforce should be included in the design process; self-assessment should not replace external regulation or audit; and standardisation was essential to support meaningful comparisons between areas and services.

30. A majority of respondents agreed or strongly agreed that some of the standards should be measured using a range of indicators. Feedback included that provision of a national set of indicators/standards could help to ensure consistent provision of quality care and support across Scotland.

31. Wider feedback included that indicators should recognise regional differences, and some respondents proposed additional indicators that could be considered by the Scottish Government.